Open AccessCooled Sacroiliac Radiofrequency Denervation for the Treatment of Pain Secondary to Tumor Infiltration: A Case-Based Focused Literature Review
Author(s) -
Steven P. Cohen
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/1
Subject(s) - medicine , denervation , radiofrequency ablation , sacroiliac joint , ablation , low back pain , intractable pain , surgery , pathology , alternative medicine
Background: The sacroiliac (SI) joint is a common cause of low back pain, for whichradiofrequency (RF) denervation has been shown to provide long-term relief. However,controversy exists surrounding the innervation, which treatment paradigm to utilize, and howbest to select patients who might benefit.Objective: To describe a patient with terminal breast cancer and tumor infiltration of thesacroiliac joint who was treated with cooled RF of the sacral lateral branches as an end-oflife palliative measure. The objectives of this review are to provide insight into the innervationof the SI joint; address controversial issues surrounding the targeted nerves in a patient withtransitional anatomy; outline risk-mitigation strategies; and highlight the need for individuallytailored treatment plans.Methods: Case-based focused literature review in a patient treated with cooled RF ablation ofthe L4-S3 primary dorsal rami and lateral branches.Results: Treatment was tailored to facilitate the rapid treatment of this terminal patient byperforming the prognostic blocks and RF ablation at the same visit. Until her death 5 dayspost-procedure, the patient reported significant pain relief and began to ambulate and use thebathroom on her own, activities she could not do before treatment. In addition to functionalimprovement, she was also able to significantly reduce her opioid intake.Conclusion: This is the first report of cooled SI joint RF ablation to treat cancer pain. Our patient’spositive response to the procedure suggests the possibility that the lateral branches innervatenot only the posterior ligaments, but also the bony articulation. The decision to proceed with RFablation on the same day as a prognostic lateral branch block was based on our patient’s terminalcondition, and the fact that cooled RF does not require sensory stimulation to ensure proximity tothe target nerves. Because of her transitional anatomy, we elected to target L4.Key words: Cancer, denervation, innervation, radiofrequency, sacroiliac joint, transitionalanatomy